Local Health Administration Committees (Clas) Opportunity And Empowerment For Equity In Health In Peru

Local Health Administration Communities (CLAS) in Peru are private, non-profit civil associations that enter into agreements with the government and receive public funds to administer primary health-care (PHC) services applying private sector law for contracting and purchasing. CLAS is an example of a strategy that effectively addresses the social determinants of health (SDH), which refers to the social, cultural and economic barriers at the local level that keep people from effectively utilizing health-care services. Initially, this started as a small-scale initiative backed by a Supreme Decree, and now there is a national law on CLAS. The Peruvian government provides a structure for more flexible financial management with social participation, which gives citizens direct control of the transparent management of PHC services. Evidence is presented comparing CLAS to PHC services administered through the traditional public system, which still operates in 70% of the Ministry of Health PHC system. This shows a positive equity effect of CLAS and greater efficiency in the use of resources. However, the process to get the CLAS to where it is now was both long and difficult, and required political trade-offs that went right to the core of the programme idea.